Being the first generation of students to be sponsored by DGHI for Mwika Uuwo, we face a lot of uncertainties. On-site conditions are a mystery and our contact person, Vera, is from KCMC in Moshi, a city more than 40 minutes away from our village. All I know for sure is that we will be living less than 5 minutes away from the clinic, that we will have no access to internet, and that the clinic has very recently purchased a computer for patients' recordkeeping. Our team has generated a list of lofty project ideas we were interested in pursuing - antenatal care, the study of chronic disease in the population, health education (on smoking, diabetes, cardiovascular disease, medication side effect), Down's syndrome, and of course, computer literacy training for hospital staff. However, many barriers stand in the way of generating well fleshed-out, workable and innovative proposals. And many questions remain unanswered.
Take medication side effects, for example. In the United States, we want drugs to be clearly labeled with all potential side effects and pharmacists to tell us how to take it, when to take it, and what symptomes to expect. There are compelling reasons for labeling and many forseable benefits to making sure this practice is adapted in less wealthy nations. While westernized medicine monopolizes the American healthcare landscape, conditions are different in other parts of the world, where a patient may seek care from a variety of sources - government sponsored clincs, religious healers, herbal medication, etc... Many view Westernized medicine as an unfamiliar new concept and approach it with caution. Now imagine a scenario where health officials try to implement a TB control program with pills which have to be taken on a rigid schedule. If the pills come with sudden and debilitating side effects (such as nausea, or diarrhea), a patient might conclude that the pills are making them sick and stop treatment. This failure to adhere can result in increased drug-resistance. So shouldn't telling patients to anticipate side effects be a good thing?
Not necessarily. The relationship between doctor and patient differs from culture to culture. Revealing that a drug can actually generate harmful effects may drastically decrease uptake. People living in endemic TB regions have been coping with the disease for generations. Perhaps being TB postive is a better alternative to symptoms of nausea, which can hinder someone from working and earning the money needed to support their families. It also can increase patient distrust, especially if other forms of "milder" medicine is available. As Americans, we are instilled with a strong sense of individualism and having the choice to make our own decisions regarding health. Paradoxically, in other countries patients do not want to be given a choice. They expect doctors to know what is best and they expect one and only one right answer. This is reflected in the numerous studies that report the frustration health care workers feel towards the ever-changing breastfeeding protocols. 6 months exclusive breastfeeding or bottle feeding only at the discretion of the mother was simply too wishy-washy of an answer.
There are so many other scenarios I can think of that can prevent us from achieving those goals. What if the language barrier is too great? Will we have someone that speaks Swahili to help implement the health education classes? What if the real solutions to chronic health care in the community are beyond our resources? Maybe those that do get cardiovascular disease have genetic predispositions and what they need the most is beta blockers, not dietary changes. What if pregnant women do not have the means to increase iron in their diet or make sure they have enough calcium? How much difference can 2 students really make?
Pondering about all those fears led me to consider my purpose in going. I am not the naive westerner who's embarking on a journey to "save the world" or "make a difference". I know that Tanzanians have more to teach me than the other way around. Nor do I hold any preconceptions of what is "right" or what people "need". Yet I cannot deny a strong desire to make the trip purposeful, to make achievements worth the funding we received. What appealed to me the most about civil service is the opportunity to generate something meaningful with my own abilities now. Gaining knowledge to prepare for a future in medicine and to become a good doctor is great, but I want to apply my Duke education now, to know that while I have many years of learning ahead of me, there are still things I can accomplish today.
Maybe I should put less weight on these reasons. We are merely students, we've only lived 21 years and we're new to the real world. Our knowledge and resources are limited. But our capacity to connect with others, to share our experiences, is boundless. We may not create great policy changes or generate sustainable programming, but we will undoubtly leave a mark on the people we meet and they in return will touch our lives deeply. Perhaps that is enough.
25 days until departure
